Counting The Cost: Caring For People With Dementia On Hospital Wards

Counting the cost
Caring for people with

dementia on hospital wards
www.alzheimers.org.uk
1. Background to the research
2. The research
3. The findings
4. Recommendations
Background to the research
Alzheimer’s Society
research
P
O
Local action E
V
L
I
I
C
Royal College of Psychiatrists audit D
E
Y
N
Strategies for Wales and NI C
C
E
O
N
National Dementia Strategy for England B
T
A
E
S
X
T National Audit Office E
• Provide detailed evidence
• Support ongoing work and move beyond

recent achievements
• All hospitals to be at standard of the best
The research
People with dementia and
carers
1. About the ward
2. Quality of dementia care on the ward
3. Leaving hospital
4. What was positive and what do you think can be done

to improve things?
People with dementia and
carers
1. About the ward
•1,291 responses
2. Quality of dementia care on the ward
•Supplementary evidence
3. Leaving hospital and information
also provided
4. What was positive and what do you think can be done
to improve things?
Nursing staff and nurse
managers
1. Training and work-based learning
2. Working with people with dementia – key challenges
3. What would help you to care for people with dementia?
4. What could be done to support the improvement of

dementia care?
5. Any examples of good practice?
Nursing staff and nurse
managers
1. Training and work-based learning
2. Working with people with• dementia – key

657 nursing challenges
staff responses
• 479 nurse manager
3. What would help you to care for peole with dementia?
responses
4. What could be done to support the improvement of
dementia care?
5. Any examples of good practice?
The findings
A good experience…
They treated him in a very person-centred way
and were always checking on him and helping
him. All staff members were very aware of his
dementia. They spoke very slowly and calmly
and never rushed him. The nurses were
amazing and there was nothing they didn’t have
time for.
A very different experience…
She had fallen out of bed and I asked the nurse how
this happened and the nurse replied: ‘I have 16 other
patients to look after’. She never left her bed again.
We asked for the jug of water to be filled and the staff
member said ‘no, that’s not my job’. Once, I found
that her pad was sopping wet and her legs were raw.
Why are people with dementia in
hospital?
• Up to a quarter of beds occupied by people with dementia
aged over 65.
• Admitted to hospital for a range of acute physical conditions:
following a fall, broken/fractured hip, urine infection (including
UTI), chest infection, stroke.
• Prevalent in a variety of wards: elderly care, surgical, general
medical, orthopaedic, rehabilitation.
• 97% of nurses work with people with dementia.
Human cost to being in hospital
• Variation in the quality of dementia care provided - 77% of carers
dissatisfied with quality of dementia care
• Over one third went through complaints system
• 47% said being in hospital had a negative effect on health
• 54% said being in hospital had a negative effect on dementia
• 77% of nurses said that antipsychotic drugs were used. Up to a quarter
thought they were not appropriately prescribed
• 53% not offered additional support on leaving hospital
• Over a third of people who went into hospital from their own homes
were discharged to a care home.
Quality of dementia care
• Lack of recognition and understanding of
dementia
• A lack of person-centred care
• Lack of help with eating and drinking
• Not as much involvement in decision making as
would like
• Few opportunities for social interaction
• Not treated with dignity and respect
Nurses concerns
•89% of nursing staff found working with
people with dementia challenging
•Over half of nursing staff not received pre-
registration or work-based training
•Over a third have some but not enough
•Key challenges are: managing difficult and
unpredictable behaviour; communication; not
enough time to provide one to one care;
wandering and ensuring patient safety
What would help nurses?
• More access to specialist advice and help - 91%

• More staff/time on wards – 90%
• Good leadership in dementia care – 87%
• More involvement with family carers – 84%
• Learning and development opportunities – 83%
Length of stay
• Majority of nurse managers felt people with dementia
have a longer stay in hospital.
• Half of carers said that the hospital stay was longer than
they expected it to be.
• The longer the stay, the worse the effect on dementia
and health; discharge to a care home more likely and
antipsychotic drugs more likely to be used.
• People with dementia are in hospital longer than the median length of stay for all NHS
patients for same reason for admission.
• Urinary tract infection – median length of stay for all NHS patients is 4 days
• 86% of people with dementia stay one week or more (at least median plus 3 days)
• 53% of people with dementia stay two weeks or more (median plus 10 days)
• 30% of people with dementia stay one month or more (median plus 26 days)
• Dementia is leading to reduced throughput and capacity
Economic cost
• Additional financial pressure is being placed on the NHS by
people with dementia staying in hospital longer.
• Supporting people with dementia to leave hospital one week
sooner can result in savings of at least £80 million and
potentially hundreds of millions of pounds.
• Urinary tract infection – 123,273 cases in 07/08; up to a quarter
of these likely to have dementia (30,800 people).
• Excess day tariff for UTI is £176, leading to savings of £38m
• This could be more effectively reinvested.
Recommendations:
Meeting the challenge of dementia
1. Recognise that dementia is a significant, growing and costly problem,
which lies at the heart of the agenda to drive efficiency and quality
improvement
2. Reduce the number of people with dementia being cared for in hospitals
3. Identify a senior clinician
4. Commission specialist liaison older people’s mental health teams
5. Ensure there is an informed and effective acute care workforce
6. Reduce the use of antipsychotic drugs to treat people
with dementia on a hospital ward
7. Involve people with dementia, carers and family in
decisions, care and treatment
8. Make sure that people with dementia have enough to eat
and drink
9. Begin to change the approach of care to one of dignity
and respect.
Thank you
Louise.lakey@alzheimers.org.uk
www.alzheimers.org.uk/countingthecost

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Counting The Cost: Caring For People With Dementia On Hospital Wards

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Counting the cost

Caring for people with

• Support ongoing work and move beyond

• All hospitals to be at standard of the best

1. About the ward

2. Quality of dementia care on the ward

4. What was positive and what do you think can be done

1. About the ward

1. Training and work-based learning

2. Working with people with dementia – key challenges

3. What would help you to care for people with dementia?

4. What could be done to support the improvement of

5. Any examples of good practice?

1. Training and work-based learning

2. Working with people with• dementia – key

5. Any examples of good practice?

• More access to specialist advice and help - 91%

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